Background: Infants with intrauterine growth restriction (IUGR) are at increased risk of perinatal morbidity and mortality in addition to long-term neurodevelopmental impairment due to fetal, placental, or maternal causes. Aim: This study aims to evaluate early childhood neurodevelopmental outcome from 18 to 24 months of age following a pregnancy complicated by IUGR. Study Design: This is an observational cohort study of prospectively collected data from a neonatal follow-up program (NFP) at the King Khalid University Hospital, Riyadh, Saudi Arabia. Results: A total of 65 IUGR infants with a median gestational age (GA) of 36 weeks (28–40 weeks) and a median birth weight of 1595 g (740–2280 g) were enrolled in the NFP. The majority of the mothers were Saudi 63 (97%), with a mean age of 30 years (19–45 years). Sixty-five percent of the infants were born by cesarean section. The prevalence of IUGR was 5.5% with predominance of symmetrical IUGR pattern 52 (80%). The median age of developmental assessment was 15 months (7–33 months). Thirty-two infants (49.2%) had a lower score (moderate 23 (35.4%) and severe 9 (13.4%) by Bayley Infant Neurodevelopmental Screening (BINS). There were no correlations between BINS category and birth weight, GA, gender, or type of IUGR. Catch-up growth was achieved in 44 (66.7%) of the infants at a median age of 9 months. Conclusion: We have demonstrated a higher incidence of poor neurodevelopmental scores at the early ages from 15 to 24 months among infants who were born following a pregnancy complicated by IUGR. BINS scores were not influenced by birth weight, GA, gender, or type of IUGR. IUGR is an independent variable for poor neurodevelopmental outcome. These patients will be followed to preschool ages for further neurocognitive assessment.

Background: Whole-body cooling is now recommended for the treatment neonates with hypoxic-ischemic encephalopathy (HIE) if started within 6 h of birth and continued for 72 h has shown to reduce the mortality and morbidity (1–4). The literature search also mentions the therapeutic beneficial effect of whole-body cooling in moderate-to-severe birth asphyxia. We publish the effect of whole-body cooling in asphyxiated neonates with resource limitation. Materials and Methods: It was a prospective interventional study of newborns admitted for HIE from October 2014 to April 2016 in Neonatal Intensive Care Unit (NICU) of Military Hospital (Level 2). There were 1565 deliveries during this period and 65 neonates with perinatal asphyxia were admitted in the unit. They were divided into two group by computer generated number so that the selection bias was minimised. The inclusion and exclusion criteria were determined as per the predesigned proforma. According to inclusion criteria, thirty inborn cases were eligible for the study group. The other control group included thirty neonates who did not receive whole-body cooling and was given treatment as per standard protocol. The remaining five babies were not included in the study group as they had mild birth asphyxia. The ethical approval and written informed consent were taken before the intervention. Inclusion criteria - Neonates born beyond 36 weeks of gestation and weight more than 2000 Grams were included in the study. The other inclusion criteria were umbilical cord or a postnatal (in the 1^st h of life) arterial blood gas pH of <7.0 or base deficit of more than or equal to 16 along with any two of the following: (1) Apgar score of <5 at 5 min; (2) positive pressure ventilation (PPV) initiated at birth and continued for at least 10 min; (3) risk factor (anyone) - intrapartum fetal distress, cord prolapse, placental abruption, and uterine rupture/dehiscence. Exclusion criteria - Neonates born before 36 weeks and reported after 6 h of birth were excluded from the study. Statistical Analysis: Statistical analysis was carried out by SPSS 17. The difference between the two groups was studied either by the nonparametric Mann–Whitney test for quantitative variables or by Chi-square test or Fisher's test for qualitative variables. Statistical difference was considered significant if P < 0.05. Results: The primary outcome was measured in terms of neurological examination at 18 months of age and secondary outcome was measured in terms of adverse outcome and complications. The detail clinical examination and Denver Development Screening test were used for the neurological and developmental assessment. The neurological outcome at discharge and at 18 months of age was better in neonates given whole-body cooling than in the control group. The normal neurological outcome at 18 months of age was 70% compared to control group of 43% with P= 0.02. Furthermore, the cognitive delay at 18 months of age was lesser than control group.

Background and Objectives: About 15 million babies are born preterm every year. Among them, almost 1 million neonates die due to complications. Even the survivors are prone to lifetime disability. Yakson touch and kinesthetic stimulation techniques have been proved to be effective in minimizing the complications and disability, but there is no standardized protocol. Hence, we aimed to investigate the efficacy of Yakson touch in combination with kinesthetic stimulation (YAKIN) on the development of high-risk neonates. Materials and Methods: Twenty-eight neonates were recruited through parental consent from a recognized tertiary care teaching hospital for this two-group pre- and post-test design of randomized controlled trial and were allocated into control group (n = 14) and experimental group (n = 14) by block randomization method. Neonatal behavioral assessment scale (NBAS) was performed on all recruited neonates. The duration of intervention was 5 days out of 7 days. The experimental group received Yakson touch and kinesthetic stimulation and the control group received conventional handling which included developmental positioning and Kangaroo mother care. On the 7^th day, NBAS was done again to document the effect of the intervention. Results: Neonates median gestational age of 35 (34, 35.3) weeks in experimental and 35 (33.5, 36) in control group were recruited. There were no significant differences between the groups (p> 0.05). Large effect size index was seen in the experimental group. Conclusions: Efficacy of the standardized protocol YAKIN has been verified, and it may have positive effects on the overall development of high-risk neonates.

Background: Asphyxia before, during, or after birth is an important cause of perinatal mortality and morbidity. The newborn infant who does not breathe at birth suffers from oxygen lack, carbon dioxide excess, and fall in blood pH. Although the fetal and neonatal myocardium seems to be resistant to hypoxia, heart failure is commonly seen after perinatal asphyxia. We performed this study to determine the incidence of cardiovascular insult in birth asphyxia. Materials and Methods: This is a prospective, observational, hospital-based study carried out on 152 asphyxiated neonates admitted in Neonatal Intensive Care Unit (NICU) of Rural Medical College of Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, from September 2013 to August 2015. Results: Cardiovascular involvement was seen in 48 (32%) of the infants who had birth asphyxia. Cardiovascular dysfunction most commonly manifested by the use of inotropes (32%) followed by abnormal echocardiography (27%), electrocardiography (ECG) changes (13%), and elevated creatinine kinase-MB (14.5%). Out of the 48 neonates who had cardiovascular system (CVS) dysfunction, 28 children survived till hospital discharge. Conclusions: CVS dysfunction is present in significant proportion of neonates following asphyxia injury and neonates with cardiovascular dysfunction have a poor outcome.

Introduction: The umbilical cord is one of the routes of entry of microorganisms that can cause infection. Hence, affordable, effective, and safe cord care regimens are needed to prevent from such infections. Methods: The study was conducted in Nehru Hospital, PGIMER, Chandigarh, with the objective to assess the effect of two cord care regimens – human breast milk and 4% chlorhexidine on bacterial colonization and other clinical outcomes. A total of 105 newborns were enrolled and randomized into three groups (35 participants in each group) – human breast milk, 4% chlorhexidine, and dry cord care group (control group). The umbilical cord swab baseline sample was taken and cultured from each of the participants. The first application (either breast milk or 4% chlorhexidine) was done immediately after the baseline cord swab sample was taken. In the dry cord care group (control group), nothing was applied on the cord. Cord swab was again taken at 72 ± 12 h and at 120 ± 12 h after birth. Umbilical cord separation time was noted. Results: There was no statistically significant difference in cord colonization at baseline (P = 0.13). At 72 ± 12 h, 34.3%, 5.7%, and 51.4% had colonization in the breast milk, chlorhexidine, and dry cord care, respectively (P < 0.001). At 120 ± 12 h, 22.9% had bacterial colonization in the breast milk group, 71.4% in the dry cord care group whereas only 2.9% in the chlorhexidine group (P < 0.001). The timing of cord separation was 9.09 ± 2.4 days, 12.65 ± 2.9 days, and 10.54 ± 3.1 days in the breast milk, chlorhexidine, and dry cord care, respectively, with maximum separation time with chlorhexidine application and least time taken in the breast milk group (P < 0.001). The main microorganisms detected were Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, Acinetobacter baumannii, Enterococcus faecium, Staphylococcus haemolyticus, and Streptococcus. Conclusion: It is concluded that 4% chlorhexidine is very effective in reducing pathogenic bacteria colonization of the cord. Further, human breast milk, to some extent, can reduce bacterial colonization in low-resource settings and is a better alternative to dry cord care.

Introduction: Fetal malnutrition (FM) is a “clinical state of a baby of any birth weight, characterized by obvious intrauterine loss or failure to acquire normal amounts of subcutaneous fat and muscle mass, manifesting as wasting, shortfalls in weight, length and other anthropometric measurements.” It is associated with increased morbidity and mortality in the newborn. Aim: The aim of this study was to determine the prevalence of and risk factors associated with FM in Port Harcourt, Nigeria. Subjects and Methods: This was a prospective hospital-based study, carried out at the labor Wards of a tertiary hospital in Southern Nigeria. Baby-mother pairs who met the inclusion criteria for the study were recruited consecutively. Relevant biodata was recorded, and babies' nutritional status was assessed using the Clinical Assessment of Nutritional Status Score chart. Data were entered into a Microsoft Excel sheet and analyzed using standard statistical tools. Results: Of 300 newborns studied, 176 (58.7%) were male and 124 (41.3%) females with a male:female ratio of 1.4:1. The prevalence of FM was (16.7%). Babies with FM had significantly lower anthropometric indices (length, occipitofrontal circumference, and mid-upper arm circumference) than their counterparts (P = 0.00). Being small for gestational age and nonuse of at least one dose of intermittent preventive treatment for malaria in pregnancy were significantly associated with the occurrence of FM (P < 0.005). Conclusion: The prevalence of FM in Port Harcourt is high and highlights the need for evolving appropriate interventions and strategies for its prevention.

Objectives: The aim of this study is to compare the stress level of neonate undergoing double-surface (DS) and single-surface (SS) phototherapy. Study Design: This was a prospective observational study. Study Setting: Neonates with indirect hyperbilirubinemia on phototherapy in Special Newborn Care Unit of Christian Hospital, Chhatarpur, Madhya Pradesh, India (A Unit of Emmanuel Hospital Association, New Delhi). Materials and Methods: The stress level of neonate under DS and SS phototherapy was assessed with COMFORT-B scale. The neonate was assessed before the start of phototherapy (zero hours) and was further assessed at 2, 6, 12, and 24 h of phototherapy. Results: A total of 94 neonates were included in the study, of which 56 (59.5%) are term and 38 (40.5%) are preterm. The maximum COMFORT-B scale score was 23, and the minimum score was 7. The mean COMFORT-B score was marginally higher with DS phototherapy at all hours of phototherapy, but it is not statistically significant. Similar observations were noted among terms and preterms. Conclusion: There is no additional stress to neonates in DS phototherapy compared to SS phototherapy.

Teratoma is a tumor that is derived from three germ cell layers, and it occurs commonly in the ovary and sacrococcygeal region. In the present study, we report a rare case of sacrococcygeal teratoma of newborn showing features of organoid lung differentiation. A 2-day-old girl child presented with left gluteal mass. Surgical excision was done, and histopathology revealed mature sacrococcygeal teratoma with adult type organoid lung differentiation which is a very rare finding.

Anorectal malformation (ARM) is a common congenital anomaly with diverse clinical presentations. It may be associated with other congenital anomalies. We operated a patient of ARM who was diagnosed to be high type of ARM. Intra-operatively, it was found to be a case of perineal fistula with jejunal atresia. Being an extremely rare presentation, it is being presented with review of relevant literature.

A case of multiple terminal ileal atresia with associated undiagnosed duplication of mid-ileum found intraoperatively is reported here.

We describe two infants with severe hemolytic disease of the fetus and newborn (HDFN) with hepatosplenomegaly treated with intravenous immunoglobulin. Packed red blood cells (PRBC) were transfused resulting in an acute disproportionate increase in hemoglobin with clinical consequences in one case. These cases appear to highlight previously unreported sequelae. We discuss a hypothetical mechanism and suggest that the effect warrants further research as a possible way to decrease the need for and risks of PRBC transfusion in HDFN.

We report a neonate with acute venolymphatic insufficiency after an endovascular procedure. The case of a newborn baby, who evolved with phlegmasia cerulea dolens, one type of acute venolymphatic insufficiency, after a venous endovascular procedure, is reported. Soon after the procedure, the child evolved with cyanosis that led to phlegmasia cerulea dolens following reperfusion of the limb. Lymphovenous drainage of the deep and superficial systems was performed that resulted in recovery of the limb. The drainage was performed for the periods of 20 min/h. The child required analgesic sedation to reduce movement of the limb, thereby diminishing blood flow. After 15 days, the patient no longer required analgesic sedation or lymph drainage.

Clinical detection of genetic disorders in early neonatal period is often difficult, particularly in the context of difficulty in recognizing subtle facial dysmorphism in prematurity. As the newer technology such as phenotype-based whole-exome sequencing is gaining popularity as the most effective and reliable way of early diagnosis more emphasis will be returned back to identify typical and uncommon phenotypical features of genetic disorders. Smith–Magenis syndrome (SMS) is a sporadic genetic disorder caused by 17p11.2 microdeletion in 90% of cases with wide variety of features ranging from intellectual disability, distinctive facial appearance, significant circadian sleep rhythm abnormality, congenital heart disease (CHD) (30%), brain and renal malformation to obvious behavioral problems, most of which, however, are appreciable only at late childhood. Currently, SMS is diagnosed by single-nucleotide polymorphism microarray. Earlier diagnosis for this sporadic condition depends on high index of suspicion, particularly for those who are missed during the fetal morphology scan. CHD can be a very important clue in the fetal or early neonatal period. In this article, we present a preterm infant with SMS in association with ventricular septal defect and vascular ring, a combination of which was not reported earlier. Notification of these atypical features is an important element of increasing the knowledge base in the process of the earlier diagnosis in future.

Oculocutaneous albinism (OCA) is an autosomal recessive disorder, phenotypically subcategorized as OCA subtype 1A (OCA-1A) and OCA subtype 1B (OCA-1B). Both the subtypes are genetically caused by the mutations in the tyrosinase (TYR) gene. A 6-month-old nonidentical twin sister was albino who was diagnosed with OCA-1A and had clinical features including hypopigmentation in iris, lid, lashes, skin, nystagmus, and albinotic fundus. Genetic screening revealed the pathogenic mutation at TYR gene locus in albino child, whereas the other child was carrier and holding normal phenotype. We report a differential TYR expression pattern on one of the nonidentical twins.